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Grand Rapids Ostomy Association
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1-1. A primary reason for assessing a patient before the creation of a stoma is to identify the patient ability and needs for learning self-care.
1-2. Priority nursing activity with a patient who will have ostomy surgery includes discussing the surgical procedure and stoma site selection
1-3. Factors that influence the assessment process.
1-4. The patient with limited vision may best learn ostomy self-care by improved lighting and teaching by touch.
1-5. Asking questions about a patient's hobbies, work, and activities aids in the evaluation of hearing, dexterity, and sexual functioning.
1-6. Preoperative patch testing of ostomy adhesives or dermatology referrals or both should be considered for patients with adhesive allergies and dermatologic disorders
1-7. Including the patient in the decision-making process should enhance the patient's sense of control.
1-8. When selecting ostomy equipment for an Islamic patient, cultural and religious factors should the nurse consider.
1-9. Examining the patient's abdomen before ostomy surgery is suggested to identify potential stoma site(s).
1-10. Examining a patient's abdomen in different positions before ostomy surgery should be performed with the patient in the lying, standing, and sitting positions. As positions shift, changes occur in the abdominal contours and the pattern of scars, thus affecting the pouch adhesive surface.
1-11.Following are principles of learning appropriate to the adult :
1-12. An example of the use of affective learning is planning a visit to the patient by an individual who has an ostomy and has returned to his or her preoperative life-style.
1-13. Factors that may interfere with early postoperative patient teaching and learning are pain, use of narcotics, nausea and vomiting, and the presence of tubes. .
1-14. Small children who are learning self-care of an ostomy:
1-15. The correct sequence of the four phases in the process of resolving alterations in body image as described by Lee is impact, retreat, acknowledgment, and reconstruction
1-16. A sexually active woman who requires a cystectomy may have difficulty with lubrication.
1-17. Sexual functioning in individuals of either sex may be affected by:
1-18. Sexual arousal in men depends on adequate blood and nerve supplies to the genitals.
1-19. The PLISSIT model interventions are permission, limited information, specific suggestion, and intensive therapy.
1-20. The use of a teaching model to explain normal sexual functioning is an example of limited information level of the PLISSIT model.
1-21. Scarring of the cavernosa bodies and sensory nerve damage are potential side effects of injecting the penis with drugs that cause priapism.
1-22. A neovagina is created in the woman who has a total pelvic exenteration.
Principels and Procedures of Stomal Management
2-1. Ileus is a normal occurrence during the first 48 to 72 hours after surgery for construction of a stoma.
2-2. A Patient who has had the terminal ileum resected or bypassed is most likely to require lifelong vitamin B12 replacement.
2-3. Common causes of stomal necrosis include:
2-4. Management of mucocutaneous separation:
2-5. Factors to be included in postoperative assessment of the stoma and peristomal skin.;
2-7. Skin sealants are effective to provide a moisture barrier and protection against epidermal "stripping" with adhesive removal.
2-8. The three major forms of skin barriers and appropriate uses for each
form.
2-9. Factors to be considered in selecting a pouching system.
a. Stoma assessment factors
2-10.The benefit of antireflux valves in urinary pouches is that they reduce backflow of urine onto the peristomal skin and thus provide peristomal skin protection.
2-11. Patient with a sigmoid colostomy is a candidate for a closed-end pouch.
2-12. Advantages of reusable pouching systems:
2-13. The nurse should wait until stoma shrinkage is complete to order reusable equipment. Stoma shrinkage usually is complete in 6 to 8 weeks after surgery.
2-14. Convex pouching system is most likely to provide an effective seal for the patient with a retracted stoma.
2-15. Ileostomy produces the most damaging effluent and therefore requires the most peristomal skin protection?
2-16. Removal of peristomal hair generally is recommended to prevent folliculitis.
2-17. Loop stomas initially are stabilized on the abdominal surface by either a fascial bridge or an external support. The purpose of this support is to prevent stomal retraction.
2-18. Use of skin barriers is optional in pouching a urinary diversion because urine is not inherently damaging to the skin.
2-19. Key content to be included in the teaching plan for each of the following
patients:
a. Patient with an ileostomy:
c. Patient with a descending or sigmoid colostomy
d. Patient with a urinary diversion
2-20. In teaching the patient with a new ostomy, pouch emptying and pouch change procedures is critical content, that is, content that must be taught before discharge.
2-21. One approach for management of minor peristomal skin irritation that
patients may be taught is;
The patient may be taught to dust skin barrier powder onto the irritated areas;
if necessary, skin sealants or water can be lightly blotted over the powder to
ensure a nonpowdery pouching surface. The patient also must be instructed to
contact the ET nurse for unusual or nonresponsive skin problems, as well as for
pouching problems resulting in skin irritation.
2-22. The lag time between ingestion of gas-forming foods and actual flatulence
in the
patient with a colostomy usually is 6 to 8 hours.
2-23. Beans, cabbage, broccoli, brussels sprouts, and beer are common gas-forming foods that the patient with a fecal diversion may wish to avoid or to eat selectively.
2-24. Describe measures the patient with a fecal diversion can use for odor
control.
2-25. The individual with a fecal diversion is just as susceptible to episodes of diarrhea as is the person with an intact bowel.
2-26.Patient with a jejunostomy is at greatest risk for fluid-electrolyte imbalance during episodes of diarrhea.
2-27. Sports drinks, broth or bouillon, fruit or vegetable juices, tea, and carbonated beverages are replacement fluids that the patient with a fecal diversion can drink to help prevent fluid-electrolyte imbalance during periods of increased fluid loss.
2-28.Measures that the patient with an ileostomy should be taught to prevent food blockage.
2-29. Criteria for use of routine colostomy irrigation as a method of
management.
2-30. Colostomy irrigation is contraindicated for a patient receiving pelvic radiation.
2-31. You are performing the initial colostomy irrigation for Grace Hester 7 days after abdominoperineal resection and sigmoid colostomy. She suddenly complains of feeling faint and hot, and then she becomes unresponsive. This condition most likely is due to Vasovagal reaction.
2-32. Mrs. Jones calls the outpatient clinic to report that the water she used to irrigate her colostomy has not returned. In talking with Mrs. Jones, the nurse should be aware that failure of irrigating solution to return most commoniy is due to fluid volume deficit.
2-33. The care of infants and toddlers with ostomies frequently is managed by
diapering instead of pouching.
Contraindications
to management by diapering:
2-35. John Williams is a 26-year old man with an ileostomy. He calls the ET
outpatient clinic
and states, "I think I have a food blockage." Questioning reveals that John is
having no output, has stomal swelling and abdominal distention, and is having
nausea, vomiting, and cramping pain.
Forcing fluids to prevent
fluid-electrolyte imbalance is an inappropriate recommendation for John at this
time.
2-36. Home relief measures are ineffective in relieving John's obstruction, and he comes to the outpatient clinic for evaluation and management. Repetitive lavage with 30 to 50 ml normal saline represents appropriate management.
2-37. Factors that may contribute to loss of bowel regulation in the patient who has managed his or her colostomy with routine irrigations.
2-38. You are asked to recommend an appropriate bowel preparation for the
patient
with a descending colostomy and Hartmann's pouch who is to have a proctoscopic
examination of the rectum.
A low-volume rectal enema
is the most appropriate recommendation.
2-39. To obtain a urine specimen for culture and sensitivity testing from a patient with a urinary diversion, the nurse should catheterize the stoma using sterile technique.
2-40. Urine acidification is contraindicated for a patient with a history of
uric
acid stones.
Chapter 3, Peristomal and Stomal Complications
3-1. Caput medusae may develop in the patient with impaired portal blood flow.
3-2. Folliculitis may develop in the peristomal area as a result of Shaving.
3-3. In the ostomy patient an oversized aperture in a urinary pouch may cause predisposition to pseudoverrucous lesions.
3-4. The patient with multiple areas of tumor growth in the peristomal area may require flexible equipment that conforms to the area on an uneven abdominal surface.
3-5. Denuded skin resulting from incorrect removal of an ostomy pouch is an example of Mechanical trauma.
3-6. Mucosal transplantation is thought to be the seeding of mucosa onto the epidermis as result of suturing the bowel to the epidermis instead of the dermis.
3-7. When skin testing an ostomy product, it should be placed on the abdominal surface.
3-8. A peristomal irritant dermatitis results from failure to allow a skin sealant to dry properly.
3-9. Melanosis coli develops as a result of long-term use of anthracene-containing laxatives.
3-10. The patient with a colostomy and a peristomal hernia may be instructed to do all of the following ;
3-12. The portion of a loop stoma most likely to prolapse is the distal loop of bowel
3-13. The patient with an ischemic colostomy should be monitored closely for Mucocutaneous separation.
3-14. Mycosis fungoides is Cutaneous T-cell lymphoma.
Chapter 4, Continent Diversions and Reservoirs
4-1. The ileoanal reservoir and Kock continent ileostomy are surgical options for patients with Chronic ulcerative colitis and familial adenomatous polyposis
4-2.The following surgical procedures typically are performed during the first stage of an ileoanal reservoir;
4-3 The length of bowel used to construct the S-shaped ileoanal reservoir is approximately 30cm
4-4.The following information should be provided to a patient after the final surgical procedure for the ileoanal reservoir;
4-5. A complication of the ileoanal reservoir may be pouchitis.
4-6. The length of bowel used to construct a Kock continent ileostomy is approximately 45cm.
4-7. A catheter typically remains in place 3 to 4 weeks after a Kock continent ileostomy.
4-8. The anticipated capacity of a Kock ileostomy is 400 to 800 ml.
4-9. The ideal stoma site for a continent urinary reservoir is away from the pubic hair line.
4-10. After a stage 1 IAR procedure, 1500 to 2000 cc/24 hr stool output is typical of the newly constructed loop ileostomy.
4-11. The patient with a loop ileostomy after a stage 1 IAR should be instructed to:
4-12. The length of bowel used to construct a Kock urinary reservoir is 60 to 80cm.
4-13. List the differences between the Kock urinary reservoir and the ileocecal
pouch.
4-14.The purpose of postoperative irrigation of a Kock urinary reservoir
or an ileocecal urinary pouch is;
mucus is created by the bowel segments used
to create these urinary
reservoirs. Unless removed routinely, it can obstruct urinary outflow and cause
the reservoir to overdistend, thereby placing stress on the suture lines and on
the continence mechanisms and increasing the risk of internal leakage.
4-15. The size catheter used to intubate:
4-16. The Indiana pouch can be constructed as an abdominal reservoir with urine exiting through the stoma or as a pelvic reservoir with urine exiting through the urethra.
4-17. A self-retaining (balloon) catheter may not be inserted into a continent urinary diversion to facilitate continuous urine drainage.The balloon may cause necrosis if left against the pouch for long periods or may damage the continence valve mechanism. A straight catheter should be inserted and secured with tape if continuous drainage is necessary.
4-18. Neobladder drainage relies on relaxation of the external sphincter and
abdominal straining facilitate
passive emptying of the neobladder. If relaxation is insufficient,
self-catheterization may be necessary.
Chapter 5, Principles of Cancer Therapy
5-1. Ostomy surgery frequently results from Bladder, cervical, and colon malignancies.
5-2. A pelvic exenteration is an extensive surgery involving removal of the bladder, female organs, vagina, and sigmoid colon. Reconstructive surgery may be performed to create a neovagina by using gracilis myocutaneous flaps from each thigh.
5-3. A palliative surgical procedure for cancer is performed to improve the quality of life.
5-4. Classifications of chemotherapeutic agents are alkylating, antibiotics, and hormones.
5-5. Vinca alkaloids are selected to interfere with cell division.
5-6. The side effects of bone marrow depression that may influence nursing care of the patient with a stoma are neutropenia and the potential for infection with the mucosa as a portal of entry; thus careful cleansing and manipulation are required to prevent damage. Thrombyctopenia can result, and excessive bleeding is a potential. Anemia that accompanies reduced oxygentation to the cells results in pale mucosa and patient fatigue in initiating self-care.
5-7. Methods of radiation therapy that may be selected for a patient with a malignancy.
5-8. When an ostomy is within a radiation field, skin and ostomy products containing bismuth and zinc should be avoided because these products may cause an increase in the dose of radiation to the skin.
5-9. The purpose of intraoperative radiation is to decrease local recurrence.
5-10. Biologic response modifiers are used as a cancer treatment to decrease local recurrence.
5-11. Autologous bone marrow transplantation is the use of the patient's bone marrow.
5-12. The potential cause of diarrhea in a patient with an ostomy who is receiving radiation therapy is; Radiation therapy may damage the intestinal villi, thus reducing the absorptive surface and capacity of the intestine.
5-13. The patient with an ostomy who is receiving cancer treatment that results
in bone marrow depression needs to be monitored for Neutropenia,
Thrombocytopenia and Anemia.
Chapter 6, Anatomy and Physiology of the Genitourinary Tract
6-1. The structures of the urinary tract include the Kidneys, ureters, bladder, and urethra
6-2. Divisions of the urinary tract include Upper and Lower.
6-3. The functions of the kidney include Acid-base regulation and waste excretion
6-4. The blood supply to the kidney is via the Renal artery.
6-5. The functional unit of the kidney is the Glomerulus.
6-6. The hormones that influence urine volume are Aldosterone and antidiuretic hormone.
6-7. Urinary stones most commonly occur at Ureteropelvic junction.
6-8. The primary functions of the bladder are Storage and elimination of urine.
6-9. The detrusor is a smooth, involuntary muscle.
6-10. In the normal bladder the urge to urinate is stimulated at a volume of 300 to 500 ml.
6-11. The length of the male urethra protects the individual from Incontinence.
6-12. Continence is voluntarily controlled by the Cerebral cortex.
Chapter 7, Pathophysiology and Diagnostic Tests
7-1. The congenital disease that results when the urogenital sinus fails to
close
properly is exstrophy.
of the Genitourinary Tract
7-2 The infant is born with an everted bladder and fusion of the mucosa to the skin in cases of bladder exstrophy.
7-3. Prune-belly syndrome has dilated, tortuous ureters, urologic features?
7-4. Artificial urinary sphincter is an option for managing Myelomeningocele.
7-5. Obstruction, hematuria, and frequency are the symptoms most commonly associated with Urethral cancer.
7-6. Ureteropelvic junction obstruction is the most common congenital abnormality of the ureter.
7-7. Three clinical manifestations or pathologic findings indicative of megaureter, vesicoureteral reflux, and ureteropelvic junction obstructionare:
7-8. Risk factors for the development of bladder cancer.
7-10. The definition of tumor staging and tumor grading is; Tumor stage describes the depth of tumor penetration through the layers of the organ. Tumor grade is the microscopic appearance of the cells and their orientation toward each other.
7-11. The most common type of bladder cancer is transitional cell.
7-12. The urologic management approach for patients with a spinal cord injury is; Management options include Credé and Valsalva maneuvers, intermittent catheterization, urethral catheter, suprapubic tube, urinary conduit or continent stoma. When the spinal cord injury is a high injury such as a cervical injury, limited mobility of the hands minimizes the success of techniques such as intermittent catheterization and the Credé and Valsalva maneuvers. Generally, these patients require urethral catheterization, suprapubic catheterization, or urinary conduit. Whatever management method is selected for any patient with a spinal cord injury, regular evaluation of the appropriateness and effectiveness of the intervention is imperative.
7-13. Radical cystectomy and ileal conduit or continent urostomy is most appropriate for Muscle-invasive bladder cancer
7-14. A person’s susceptibility to urinary tract infection (UTI) from an ileal
conduit,
vesicoureteral reflux, ureteral stones, and fluid intake is;
Ileal conduit
bypasses the urethra that serves as a normal barrier to bacteria; in addition,
free reflux at the ureteroileal junction allows retrograde reflux of urine (and
bacteria) into the ureters.
Vesicoureteral reflux
indicates that the normal antireflux mechanism of the vesicoureteral junction
is not functioning and that, just as free reflux of urine occurs in the
ureters, so, too, bacteria can migrate in a retrograde fashion.
Ureteral stones
serve as a nidus for bacteria to proliferate but also may occlude the ureter
and cause stagnation of urine, thus rendering the host more susceptible to an
infection.
Fluid intake
is a mechanism of clearing the urinary tract of transient bacteria. When the
fluid intake is decreased, the person becomes more vulnerable to urinary tract
infection.
7-15. Reflux of urine is the common cause of chronic pyelonephritis.
7-16.The three points of uretal narrowing where stones may form are:
8-1. Urinary diversions may be created in any area of the urinary system except
the renal parenchyma.
8-2. Three reasons for the creation of a urinary diversion. These diversions
can
be temporary
or permanent and are required when injury or disease dictates removal of the
bladder:
8-3. Hemorrhage, Infection or Obstruction can occur when a nephrostomy tube is inserted.
8-4. Six types of ureterostomy urinary diversions that may be created are,
8-5. The most frequently performed urinary diversion is a ileal conduit.
8-6. The Turnbull loop technique is used to create a urinary stoma and diversion in situations of obesity.
8-7. When an intestinal conduit is constructed, the ureters are to the bowel segment at the Proximal end or side of the conduit.
8-8. A jejunal urinary conduit may result in hyperkalemia, hyponatremia, and hypochioremia electrolyte disturbances?
8-9. Complications of ureterosigmoidostomy that may occur include Hyperchioremia and hypokalemia
8-10. Cystostomy and vesicostomy urinary diversions are performed at the level
of
the bladder.
Chapter 9 Anatomy and Physiology of the Gastrointestinal Tract
9-1. The small bowel is critical to life and health.
9-2. The four layers of the intestinal wall, from inside to outside:
9-3.Meissner's plexus, located in the submucosal layer, and Auerbach's plexus, located in the muscularis, are jointly known as the intramural plexus. It is composed of nerve cell bodies and nerve fibers, or processes; the nerve fibers originate in receptor cells located in the bowel wall. These receptors are sensitive to local stimuli, such as stretch. The intramural plexus is the primary mediator of intestinal secretion and motility. Autonomic nerve fibers synapse on nerve cells in the intramural plexus and serve to modify its response, but autonomic stimulation is not critical to intestinal secretion or motility.
9-4. Mechanical breakdown of food particles is the most important function of the structures and secretions of the mouth.
9-5.The daily volume of secretions to the each organ:
9-6. Swallowing is initiated voluntarily but is completed on a reflex basis.
9-7. The pharyngoesophageal sphincter prevents reflux of food and fluid from the esophagus into the mouth; the esophagogastric sphincter prevents reflux from the stomach into the esophagus.
9-8. Why a transmural inflammatory process may cause a generalized
inflammation of the peritoneum (peritonitis);
The outer layer of the bowel wall, the serosa, is continuous with the
visceral pentoneum, which covers abdominal organs. Inflammation of the serosa
may spread to involve the peritoneal structures.
9-9. The relationship between the mesentery and the peritoneum is;
The mesentery is a double layer of peritoneum that encircles most of the
small intestine and anchors it to the posterior abdominal wall. The mesentery
is a vital support structure because it contains the blood vessels and nerves
that nourish and innervate the bowel.
9-10. Two mechanisms that help to protect the gastric and duodenal mucosa from the ulcerating effects of gastric secretions are:
9-11. Caffeine has a stimulant effect on gastric secretion?
9-12. Five functions of the stomach:
9-13.High-fat meal is known to slow the rate of gastric emptying.
9-14. The absorptive surface of the small bowel is tremendously increased by the Villi.
9-15. The small intestine plays an important role in maintenance of fluid-electrolyte balance.
9-16. Blood flow for most of the small intestine is provided by the Superior mesenteric artery.
9-17. The major function of the duodenum is Neutralization of chyme.
9-18. Most nutrients, vitamins, and minerals are absorbed in the Jejunum.
9-19.The impact of massive ileal resection on absorption of vitamin B12 is;
Absorptive sites for vitamin B12 are located only in the terminal ileum.
Significant ileal resection places the individual at risk for pernicious anemia
and may necessitate lifelong replacement of vitamin B12.
9-20.The structure and purpose of the ileocecal valve is;
The ileocecal valve is a one-way valve located at the junction between the
ileum and the large intestine; it serves to regulate emptying into the large
intestine and to prevent reflux of colon contents back into the small intestine.
9-21.The effects of the taeniae coli on the colon wall and implications
for construction of loop colostomies is;
The taeniae coli are three muscle bands that create sacculations in the
colon wall known as haustrations. If a loop colostomy is opened parallel to the
taeniae, the natural haustrations create two separate openings, one proximal
and one distal; this separation provides almost complete diversion of the fecal
stream.
9-23. The following are functions of the anaerobic bacteria found in the colon;
9-24. Total colonic length in the adult averages 5 to 6 feet.
9-25.The significance of valves of Houston is;
The valves of Houston are three folds located in the rectum, two on the
left and one on the right; they serve as landmarks and must be carefully
negotiated during proctoscopic examination.
9-26. The rectum normally is empty.
9-27. Differentiation among gas, liquid, and solid is provided by sensory receptors located in the anal canal distal to the dentate line (anoderm).
9-28. The following accurately describes the response of the anal
sphincters to rectal distention;
9-29. "Mass movements" occur primarily in the left colon and are responsible for propelling the fecal bolus into the rectum.
9-30.Description of the endocrine and exocrine functions of the pancreas;
9-31. The liver is capable of regeneration.
9-32.Key functions of the liver.;
9-33. The gallbladder's primary function is the collection, acidification,
concentration, and storage of bile.
Chapter 10, Pathophysiology and Diagnostic Studies of the Gastrointestinal
Tract Disorders
10-1. Hirschsprung's disease is characterized by the Absence of the distal migration of ganglionic cells.
10-2. The neonate with symptoms of intestinal obstruction, failure to pass meconium, dilated hypertrophied proximal ileum, and narrowed distal ileum filled with pelletlike stool is likely to have Meconium ileus disease.
10-3. Anorectal malformations are classified as high, low, or intermediate by determining the position of the terminal bowel to puborectalis muscle.
10-4.The difference among diverticulitis, diverticulosis, and diverticular
disease;
Diverticular disease
describes the presence of diverticula in the colon and the concurrent muscular
abnormalities of the colon (shortening of the longitudinal taeniae and
thickened muscular crescents). Abdominal pain may result from muscle spasms, or
an inflammatory process (
diverticulitis
) may cause symptoms such as temperature, pain, leukocytosis, and nausea.
Complications such as perforation and obstruction may occur with this disease.
Diverticulosis
is the presence of diverticula scattered throughout the colon, without muscle
abnormality of the colon. Diverticula are present in many persons who are
unaware of them because they are symptomless. Complications rarely accompany
diverticulosis.
5. Comparison and contrast of Crohn's disease and ulcerative colitis:
Pathologic features
10-6. Biopsies are used to confirm the diagnosis of the following diseases except:
10-7.The following statement is true of extrahepatic biliary atresia;
Ascending cholangitis is a common complication of corrective surgery.
10-8. Episodes of gross or occult bloody stools in the neonate is a suspect symptom for Necrotizing enterocolitis.
10-9. Definitions:
Dynamic obstruction:
Dynamic obstruction is a surgical emergency. The source of the occlusion can
be from within the lumen of the bowel, from external compression of the bowel,
or from within the bowel layers. Adhesions are the most common cause of small
intestinal dynamic obstructions whereas colon cancer is the most common cause
of large bowel dynamic obstructions.
Adynamic obstruction:
This type of obstruction, which results from an absence of peristalsis such as
in paralytic ileus, is a temporary condition that resolves once the initiating
cause is corrected.
Closed-loop obstruction:
A closed-loop obstruction is created by an obstruction in the colon and a
patent ileocecal valve. Because this valve normally is closed to prevent reflux
into the ileum, it also serves to trap colonic material (gas and feces) between
the site of obstruction and the ileocecal valve. Distention of the bowel can
then develop, with the potential for perforation.
10-10. Features and diseases:
10-13. Desmoid tumors, osteomas, and duodenal polyps may be extraintestinal manifestations of Familial adenomatous polyposis.
10-14. Risk factors for the development of colorectal cancer.
10-15.A low anterior resection is not a curative operation for ulcerative colitis or familial adenomatous polyposis.is:
10-16. The Soave and Swenson procedures are corrective surgical techniques for Hirschsprung's disease.
10-17.Metronidazole is used more commonly in Crohn's disease than in ulcerative colitis.
10-18. Radiation effects on the bowel are not transitory and do not resolve
within
2 to 4
weeks.
Chapter 11, Gastrointestinal Surgical Procedures
11-1. End colostomy with abdominoperineal resection of the rectum is always constructed as a permanent diversion?
11-2. Permanent ileostomy is most commonly performed for Crohn's disease involving the entire colon and rectum
11-3. A Brooke ileostomy refers to an end ileostomy that is matured at the time of surgery.
11-4. Mucocutaneous separation may lead to development of stomal stenosis.
11-5. Food blockage occurs only in the patient with an ileostomy.
11-6. Common indications for a temporary colostomy:
11-7. Permanent colostomy is most commonly performed for management of carcinoma of the rectum.
11-8. Cecostomy is the not the procedure of choice for decompression of the right colon.
11-9. External support devices for loop stomas usually can be removed about 1 week after surgery.
11-10. Loop colostomies usually provide almost complete diversion of the fecal stream, especially if the loop is opened longitudinally.
11-11.Indications for construction of a double-barrel ostomy:
11-13. Four principles for construction of an end stoma (such as an end sigmoid
colostomy):
11-14. The reason why a descending or sigmoid colostomy stoma can be
constructed
so that it is almost flush with the skin, whereas an ileostomy must be
constructed so that it protrudes above skin level.
The stool from a descending or sigmoid colostomy is much easier to contain
because it usually is soft and formed, and it is much less damaging to the skin
because it contains no proteolytic enzymes. Ileostomy output is fluid to mushy
in consistency and is extremely damaging to the skin as a result of its
proteolytic enzymes. Therefore it is important for the ileostomy stoma to
protrude above skin level and to project into the pouch.
11-15. Stomal necrosis extending to fascial level mandates emergent surgical intervention.
11-16. Avoiding an overly large opening in the fascial muscle layer helps to prevent stomal prolapse and parastomal hernia formation.